La preparazione intestinale ha cambiato da febbraio 2013

La preparazione intestinale ha cambiato da febbraio 2013 La preparazione intestinale per la chirurgia dell’endometriosi profonda non è stata chiara. Vedere il nostro review recente. Per la resezione intestinale chi sono più svantaggi che vantaggi per la preparazione intestinale meccanica completa come fatta per la colonoscopia. Il nostro dubbio è stato la perforazione tardiva ma il RCT non è possibile e prenderebbe 20 anni Dopo la discussione recente nel AAGL-endo Il Gruppo Italo Belga ha preso la decisione oggi, il 6 febbraio 2013, de non più fare la preparazione intestinale completa ed meccanica ma di fare la dieta per 3 giorno con poco fibre + un clistere la sera + antibiotici . per leggere la discussione...

Are meshes dangerous for pelvic floor repair ? Why FDA recommendations are unsatisfactory.

Are meshes dangerous for pelvic floor repair ? Why FDA recommendations are insufficient. SUMMARY OF RECOMMENDATIONS (for full data see article ) click to read full article For surgeons who do not currently perform transvaginal placement of surgical mesh for pelvic organ prolapse, but wish to begin performing this procedure: a. General knowledge should be documented either by completing a fellowship training program in Urogynecology, Female Pelvic Medicine and Reconstructive Surgery, or Female Urology or by completing adequate CME in pelvic anatomy and reconstructive pelvic surgery. b. Specific knowledge for a particular procedure should be obtained c. Skill may be documented by surgeons who have completed a Urogynecology, Female Pelvic Medicine and Reconstructive Surgery or Female Urology fellowship program via cases lists showing experience with transvaginal placement of surgical mesh for pelvic organ prolapse. Surgeons who do not have documentation of prior training with a specific transvaginal mesh prolapse procedure should be proctored on no fewer than 5 procedures or as many as is necessary to demonstrate that they can independently perform the specific procedure. d. Experience in treating women with pelvic floor disorders should be documented either by completing a fellowship training program in Urogynecology, Female Pelvic Medicine and Reconstructive Surgery or Female Urology or by demonstrating that they offer a full spectrum of surgical options for pelvic floor disorders and that surgery for pelvic floor disorders represents >50% of their surgical practice including a minimum of 30 surgical cases for pelvic organ prolapse annually. e. Demonstrate experience and privileges in nonmesh vaginal repair of prolapse including anterior colporrhaphy, posterior colporrhaphy, and vaginal colpopexy (eg, uterosacral or sacrospinous...

Isterectomia laparoscopica di utero di peso superiore al kilo

Isterectomia laparoscopica di utero di peso superiore  al kilo Due giorni fa ho eseguito  una isterectomia (asportazione dell’utero) superiore ad 1 Kg per via totalmente laparoscopica, in una donna di 50 anni , con pregresso Taglio cesareo e nessun parto vaginale. L’intervento è durato 2 0re e 20 minuti, perdita di sangue insignificante,(il valore dell’HGb è sceso da 10.4 a 9.8). La paziente è stata molto bene ed è potuta tornare a casa in 48 ore Nel 1996 abbiamo fondato negli Stati Uniti il “Kilo Club” , una associazione aperta a tutti i ginecologi laparoscopisti che avevano eseguito una isterectomia laparoscopica di utero superiore al Kilo, eravamo per lo più i pionieri di una nuova tecnica chirurgica che stava rivoluzionando la chirurgia ginecologica. d eravamo in pochi, ma anche se sono passati 16 anni da allora, ancora oggi la tecnica chirurgica laparoscopica non si è così diffusa come dovrebbe essere e come erano le nostre aspetative,nonostante il notevole vantaggio per le pazienti, ancora oggi l’utero grande superiore al kilo rappresenta un limite e solo pochi realmente esperti di chirurgia laaproscopica avanzata possono eseguire questo intervento. In realtà non è facile se non si opera con un team altrettanto esperto e con una strumentazione adeguata. esistono naturalmente degli accorgimenti per far diventare un utero grande virtualmente più piccolo, il trocar da 10 che utilizziamo per la videocamera va inserito due/3 dita sopra l’ombelico, e l’utero sembra più piccolo,per il resto bisogna sapere che non sempre è possibile eseguire la classica e standardizzata tecnica laparoscopica, ma adattarsi alla mobilità dell’utero ed all’accesso possibile e quindi la strategia operatoria può cambiare. La...

Errore e qualità in chirurgia ginecologica

Errore e qualità in chirurgia ginecologica Surgical mistakes and surgical quality Recently, surgical mistakes have been highlighted in the Belgian press because of some “forgotten ” surgical instruments in the abdomen of patients. Fortunately this occurs very rarely. It has been said that more people die every year because of surgical mistakes than by car accidents ( Google ‘surgical mistakes’ ) and the problem and the stakeholders become clear. This however is only the tip of the iceberg. The most frequent problem indeed in surgery is informed consent based upon incomplete information and lack of information concerning surgical quality. For most patients it is not very clear which quality of surgical care will be given this varies from the best available to the current practice, which is the medio legal standard. This can be highlighted by the observation that it takes between 10 and 20 years or longer before innovation is introduced; the slow introduction of laparoscopic surgery is an example of this. This website principal aim therefore is information of the patient. Surgical quality often is suboptimal There is no quality control for the individual surgical intervention . National statistics only reveal complications, while it is very hard to demonstrate the eventually underlying mistake. For this reason we published a few years ago the recommendation that systematic videoregistration of complete interventions should be mandatory. Although this would permit evaluation afterwards, videoregistration is strongly opposed for various reasons, medico legal considerations being one of them. One aspect, however should be crystal clear,and that is the the price which cannot be a problem since the cost of a DVD, sufficient...

Chirurgia laparoscopica e chirurgia robotica

Chirurgia laparoscopica e chirurgia robotica During  an endoscopy meeting in Lisbon the use of robots was extensively discussed and this promted us to write this text. Laparoscopic surgery really started to be developed at the end of the eighties ie more than 20 years ago. Since then we witnessed its development and the progressive demonstration of its superiority in comparison with open traditional surgery.  Patients indeed have less pain, a shorter hospital stay without a scar while the surgical intervention and the complication rate remain the same. As milestones in gynaecology we had after minor surgery, the introduction of the hysterectomy in 1990,  endometriosis surgery,  the pelvic floor surgery and promontofixation in the mid 90  followed by lympnode resection.  After 2000 not so much did change change anymore neither concerning surgical techniques nor for equipment. This can best be judged by the live surgeries  performed at the yearly meetings of the ESGE, of the AAGL and at many other dedicated meetings. Yet the  introduction of  endoscopic surgery into main street gynaecology was much slower.  Many of the endoscopists indeed did their last laparotomy  somewhere in the last century (for me in 1996)  and performed all interventions by laparoscopy, except some extreme cases as hysterectomies for a uterus of more than 2000 grams.  This is in sharp contrast with the overall situation in most countries. In Belgium and Italy and the USA the percentages of total laparoscopic hysterectomies, considerd level I still does not reach 10%. For level II surgeries and certainly for the more advanced level III surgery the figures are even lower.  The best explanation for this is that...

Shiny Trinket

Shiny trinkets are shiny.